If you apply for long-term disability benefits and you receive a denial, you must appeal that denial by going through the insurance company’s administrative review process. For claims governed by ERISA, exhausting your administrative remedies is mandatory before you can take your appeal to court. Some insurance policies or companies provide for two levels of administrative review, while some only have one level of review. After exhausting these administrative remedies and still receiving a denial of benefits, your next option is to file a lawsuit in federal court to challenge the insurance company’s denial of benefits.
A U.S. District Court handling an LTD benefits case has a few different options for resolving the matter. First, the court can decide that the insurance company is right and that you don’t qualify for long-term disability benefits. Likewise, the court can decide that the insurance company was wrong, you were right, and you do qualify for long-term disability benefits. A third option, however, is for the court to make no decision, but to remand or send the case back to the insurance company to reconsider a particular issue.
One situation in which a remand may occur is when the definition of disability in the LTD policy changes, such as from an “own occupation” to an “any occupation” definition of disability. This policy definition often changes after you have drawn 24 months of benefits, or a similar period. The insurance company may make the argument, for instance, that it didn’t have a change to consider the claim under the “any occupation” definition that now applies to your policy, since the policy definition change just went into effect.
Although ERISA does not specifically allow federal courts to utilize remand as an option in considering LTD claims, various court decisions have upheld its usage. However, courts are supposed to use this option “sparingly.”
From a theoretical standpoint, the concept of remand as an option for federal courts stems from the requirement that claimants exhaust their administrative remedies before they can take the matter before a court. If there is an element of the claim that the insurance company arguably didn’t consider before the claimant filed the lawsuit, then remand may be the proper option for the court to exercise.
Bonnici Law Group provides client-focused representation throughout the ERISA claims process. We are here to consider the evidence in support of your ERISA long-term disability claim and evaluate your application. Next, we can develop the most effective strategy for fighting any denials of coverage that you may receive. Allow us to handle your legal needs while you focus on your physical and emotional health. Contact the ERISA long-term disability attorneys of Bonnici Law Group at 619-259-5199 or email@example.com.